Lecture 11.1: Gynaecological Tumours Flashcards
Where can Gynaecological Tumours occur?
- Cervix
- Endometrium
- Myometrium
- Ovary
- Vulval tumours
- Tumours of gestation
What age does Cervical Screening start?
- 25
- Every 3 years
When does Cervical Screening stop?
- Every 3 years till 49 years
- 5 yearly 50-64 years
What are they testing for in Cervical Screening?
HPV (16/18)
What is done if HPV positive/abnormal smear?
- Abnormal/positive – referred for cytology +/-
- Abnormal – colposcopy and cervix biopsy
Pleomorphism
Risk Factors for Cervical Carcinoma (6)
- Sexual Intercourse
- Multiple Partners
- Immunosuppression
- Cigarette Smoking
- Early first pregnancy and increasing risk with each
subsequent pregnancies - Familial tendency
How does cervical cancer present clinically? (5)
- Early Stages are Asymptomatic
- Abnormal Vaginal Bleeding
- Post-Coital Bleeding
- Blood Stained Discharge
- Pain Radiating to Sacral Region
What are the 2 types of cervical malignancy?
1) Squamous cell carcinoma
2) Adenocarcinoma
Where can metastasis from cervical cancer via direct invasion happen? (4)
1) Around Cervix (Ureters)
2) Around Uterus
3) Rectum (causing fistulas)
4) Urinary Bladder (causing fistulas & ureteric
obstruction)
Cervical Carcinoma pattern of lymphatic spread (6)
- Parametrial Nodes
- Oburator Nodes
- External Iliac Nodes
- Common Iliac Nodes
- Pre-Sacral Nodes
- Par-Aortic Nodes
What are the 2 Types of Uterine Tumours? ()
- Benign ‘fibroids’ (smooth muscle tumour of the
myometrium) - Malignant adenocarcinoma of the endometrium
Risk Factors for Endometrial Adenocarcinoma (8)
- Unopposed Oestrogen
- Nulliparous
- Early Menarche
- Late Menopause
- Iatrogenic
- Obesity
- Diabetes/Hypertension
- HRT
What age is the peak incidence of Endometrial Adenocarcinoma?
55-65 years
Signs and Symptoms of Endometrial Adenocarcinoma (4)
- Post Menopausal Bleeding
- Difficult or Painful Urination
- Pain During Intercourse
- Pain and/or Mass in the Pelvic Area
What are the most common Myometrial Tumours? (3)
- Smooth Muscle Leiomyoma(fibroids)
- Benign Tumours
- Single or Multiple
Malignant Mesenchymal Tumours (2)
- Leiomyosarcoma (highly malignant, poor prognosis)
- Endometrial stromal sarcomas
Ovarian Neoplasms
- 80% benign
- Mostly young women 20-45 years
- Borderline tumours at slightly older age
- Malignant tumours – older women 45-65 years
Investigations for Ovarian Cancer (2)
- CA125 Blood Test
- Transvaginal Ultrasound
Types of Epithelial Ovarian Tumours (5)
- Serous
- Mucinous
- Endometrioid
- Clear Cell
- Brenner (transitional cell)
What are Sex Cord Stromal Tumours?
- These are neoplasms which frequently produce
steroid hormones - May be benign or malignant
Types of Sex Cord Stromal Tumours (3)
- Granulosa Cell Tumour
- Thecoma
- Leydig Cell Tumour
Embryonic Ovarian Germ Cell Neoplasms: What is an Immature Teratoma?
A type of malignant germ cell tumour that is often made up of several different types of tissue, such as hair, muscle, and bone
Embryonic Ovarian Germ Cell Neoplasms: What is a Dysgerminoma?
- A type of cancer that begins in germ cells in females
- Malignant
- Oocyte pure malignancy
- Very radiosensitive, so good prognosis
Embryonic Ovarian Germ Cell Neoplasms: What is a Monodermal Tumour?
Benign
Extra-Embryonic Ovarian Germ Cell Neoplasms
- All are Malignant
- Yolk Sac Tumour
- Choriocarcinoma
- Endodermal Sinus Tumour
What are Krukenberg Tumours?
It is a metastatic disease to the ovaries composed of mucin-rich signet-ring cells, comes from gastric cancer cells
Extra-Mammary Paget’s Disease (EMPD)
- It is a rare, slow-growing disease that is a pre-invasive
form of skin cancer - Presents as pruritic red area on labia majora or
around nipple - Mucin containing adenocarcinoma cells in the
epidermis
Gestational Trophoblastic Disease: Placental Tumours (3)
- Hydatidiform Mole: Partial or Complete Mole
- Invasive Mole
- Choriocarcinoma
What is a Hydatidiform Mole?
- Is a rare mass or growth that forms inside the womb
(uterus) at the beginning of a pregnancy - Grape like villi, holes
- Monitored by HCG levels (serum and urine)
- If level rises, patient will receive chemotherapy
- Neoplastic potential of complete mole greater than
partial mole - Followed up and patients advised not to get pregnant
What is a Choriocarcinoma?
- Rare malignant tumour associated with high mortality
- Usually follows hydatidiform mole, can follow
miscarriage or very rarely normal pregnancy - Malignant tumour of trophoblast: syncytio- and
cytotrophoblast in layers
What is CIN?
Cervical Intraepithelial Neoplasia
3 Degrees: I, II, III
What part of the cervical epithelium more commonly becomes cancerous?
Ectocervical Epithelium
What morphological change does HPV cause in the cervix?
Koilocytosis
Normal vs Abnormal Ectocervical Epithelium
- Large cells, small nucleus
- Larger cells, darker stain, larger nucleus
What does Carcinoma in situ mean?
Basement membrane is still intact, cancer has not invaded the basement membrane
Why is it concerning if cervical cancer spreads to the ureters?
- Causes compression/blockage of the ureters
- This leads to back-flow of urine
- This can cause kidney failure which can be fatal
What is Gardasil?
HPV Vaccine
Important Facts about Fibroids (5)
- Oestrogen Dependent
- Dysmenorrhea
- Menorrhagia
- Infertility
- Issues during Pregnancy
What substances do Germ Cell Tumours produce that can help us to monitor the disease? (2)
- Beta-human chorionic gonadotrophin (B-HCG)
- Alfa-feto-protein (AFP)
What Types of Vulval Tumours are there? (4)
- Squamous Carcinoma
- Adenocarcinoma
- Basal Cell Carcinoma
- Malignant Melanoma
Why does Obesity increase risk of breast and endometrial cancers?
Body fat has an enzyme called aromatase that converts testosterone into oestrogens, and oestrogen is linked to incidence of these cancers
Why does Choriocarcinoma have a good prognosis (if caught on time) even though it has a high propensity for systemic metastasis to genital tract, lungs and brain?
Because the cancer cells are very rapidly dividing, it makes them incredibly susceptible to chemotherapy and radiotherapy
